| 胫骨冠状面弯曲导致全膝关节置换术后胫骨假体力线不良 |
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投稿时间：2021-10-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 吴鹏 |
WU Peng |
温州医科大学附属第一医院, 浙江 温州 325000 |
The First Affiliated Hospital of Wenzhou University, Wenzhou 325000, Zhejiang, China |
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| 郎俊哲 |
LANG Jun-zhe |
温州医科大学附属第一医院, 浙江 温州 325000 |
The First Affiliated Hospital of Wenzhou University, Wenzhou 325000, Zhejiang, China |
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| 吴聪聪 |
WU Cong-cong |
温州医科大学附属第一医院, 浙江 温州 325000 |
The First Affiliated Hospital of Wenzhou University, Wenzhou 325000, Zhejiang, China |
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| 陈雷 |
CHEN Lei |
温州医科大学附属第一医院, 浙江 温州 325000 |
The First Affiliated Hospital of Wenzhou University, Wenzhou 325000, Zhejiang, China |
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| 何莉莉 |
HE Li-li |
温州医科大学附属第一医院, 浙江 温州 325000 |
The First Affiliated Hospital of Wenzhou University, Wenzhou 325000, Zhejiang, China |
676421236@qq.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第1期，第54-58页 |
| DOI：10.12200/j.issn.1003-0034.2022.01.011 |
| 基金项目:温州市基础性科研项目（编号：Y20190275） |
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中文摘要:
目的：探讨行全膝关节置换术（total knee arthroplasty，TKA）患者中胫骨冠状面弯曲对胫骨假体对线的影响。
方法：自2019年7月至2021年4月，选取全膝关节置换术治疗的100例膝关节骨性关节炎患者，术前摄下肢全长X线片并测量胫骨冠状面弯曲角度（tibial bowing angle，TBA），TBA>2°为胫骨弯曲，分为胫骨弯曲组和非弯曲组。胫骨弯曲组40例，男9例，女31例，年龄56～84（69.22±7.10）岁；非弯曲组60例，男19例，女41例，年龄51～87（70.80±7.21）岁；测量并比较两组患者术前胫骨长度（tibial length，TL）及胫骨平台内翻角（medial proximal tibial angle，MPTA）。术后3 d～1周再次摄下肢全长X线片，测量并比较两组术后胫骨假体内侧角（tibial component coronal alignment angle，TCCA）以及胫骨假体力线不良率。采用Pearson法对TCCA与年龄、TCCA与身高、TCCA与体重、TCCA与BMI、TCCA与TBA、TCCA与TL及TCCA与MPTA进行相关性分析；采用Spearman法对TCCA与性别、TCCA与Kellgren-Lawrence（K-L）分级进行相关性分析。
结果：100例患者均顺利完成手术并获得满意的术后站立位全长X线片。胫骨弯曲组与非弯曲组TL、MPTA、TCCA比较差异均无统计学意义（P>0.05）。胫骨弯曲组力线不良率为22.5%，非弯曲组力线不良率为6.67%，差异有统计学意义（P<0.05）。相关性研究发现，TCCA与TBA有强相关性（r=-0.702，P<0.01），与MPTA存在较弱相关性（r=0.311，P<0.01），与其余参数均无相关性（P>0.05）。
结论：行全膝关节置换的膝关节骨性关节炎患者中胫骨弯曲会导致术后胫骨假体力线不良，手术时需注意胫骨近端垂直胫骨机械轴截骨及假体正确安装，以免假体对线不良。 |
| 【关键词】胫骨 关节成形术,置换,膝 假体和植入物 |
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| Coronal curvature of tibial leads to malalignment of tibial prosthesis after total knee arthroplasty |
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ABSTRACT
Objective: To investigate the effect of tibial coronal curvature on the alignment of tibial prosthesis in patients undergoing total knee arthroplasty (TKA).
Methods: From July 2019 to April 2021,100 patients with knee osteoarthritis were treated with total knee arthroplasty. Before operation,the full-length films of lower limbs were taken and the tibial bowing angle(TBA) was measured. TBA more than 2° was tibial bending,which was divided into tibial bending group and non bending group. There were 40 cases in tibial bending group,9 males and 31 females,aged 56 to 84 years old with an average of (69.22±7.10) years. There were 60 cases in the non bending group,19 males and 41 females,aged from 51 to 87 years old with an average of (70.80±7.21) years. The preoperative tibial length (TL) and medial proximal tibial angle (MPTA) were measured and compared between the two groups. The full-length X-rays of the lower limbs were taken again 3 days to 1 week after operation. The medial angle of the tibial component coronal aligement angle (TCCA) and the outilier rate of force line of the tibial prosthesis were measured and compared between the two groups. Pearson method was used to analyze the correlation between TCCA and age,TCCA and height,TCCA and weight,TCCA and BMI,TCCA and TBA,TCCA and TL,TCCA and MPTA; Spearman method was used to analyze the correlation between TCCA and gender,TCCA and Kellgren-Lawrence(K-L) grade.
Results: All 100 patients successfully completed the operation and obtained satisfactory full-length X-rays in standing position. There was no significant difference in TL,MPTA and TCCA between bending group and non bending group(P>0.05). The outilier rate of force line in tibial bending group was 22.5%,and that in non bending group was 6.67%,the difference was statistically significant(P<0.05). The correlation study found that TCCA was strongly correlated with TBA(r=-0.702,P<0.01),weakly correlated with MPTA(r=0.311,P<0.01),and had no correlation with other parameters(P>0.05).
Conclusion: In patients with knee osteoarthritis undergoing total knee arthroplasty,tibial bending will lead to poor force line of tibial prosthesis. During operation,attention should be paid to osteotomy of proximal tibial vertical tibial mechanical axis and correct installation of prosthesis to avoid poor alignment of prosthesis. |
| KEY WORDS Tibia Arthroplasty,replacement,knee Prostheses and implants |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 吴鹏,郎俊哲,吴聪聪,陈雷,何莉莉.胫骨冠状面弯曲导致全膝关节置换术后胫骨假体力线不良[J].中国骨伤,2022,35(1):54~58 |
| 英文格式: | WU Peng,LANG Jun-zhe,WU Cong-cong,CHEN Lei,HE Li-li.Coronal curvature of tibial leads to malalignment of tibial prosthesis after total knee arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(1):54~58 |
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